How to create better drug takers

Although lots of data has been collected to figure out why patients don’t take their medications or don’t take them properly, designing a system to solve that problem that works for every patient equally across a health system has been elusive.

One reason is it’s complicated. Merck’s research on the subject highlights some of the reasons people don’t take their medications. In a study published last year, it determined that paying for the medication/a financial hardship was the top reason, followed by fear of or experience of side effects, then generic concerns about medications and lack of perceived need for the medication.

A study of more than 24,000 with chronic illnesses like asthma, hypertension, diabetes, osteoporosis and depression published last week looked at inadvertent nonadherence and found it goes beyond forgetfulness, running out of meds and careless. It found  a strong link between why patients don’t take their drugs and those who unintentionally don’t take them properly. “It has also been recently linked to perceived need for medications, medication concerns and beliefs about treatment efficacy, which suggests that interventions focusing on patients’ medication beliefs may be required to address both intentional and unintentional nonadherence,” according to the report.

Merck in the past 10 years has examined medication adherence and has worked with pharmacists and healthcare providers on projects to improve it.


Dr. Thomas Graf, chairman for Community Practice at Geisinger Health System, is the clinical lead for Geisinger on a multiyear collaborative program with Merck to implement ways to improve medication adherence across its health system.

“Patients may not believe this medication is best for them and think other ways are more effective. Patients may not believe they need to take medication because they feel fine, such as with hypertension. The question is does the patient believe a treatment regimen will reduce it?”

When taking a drug produces almost instant results like for asthma patients, for example, it’s a lot different. One area the program is looking at is demonstrating to patients how their health improves or worsens, depending on whether they take the prescribed drugs. “That tool would be incredibly useful for doctors and patients,” Graf said.

One challenge is just getting at the data that is stored across different computer systems, like pharmacy fill data. Part of the work Geisinger is doing with Merck is to implement a way to provide this information to doctors that fits in with the physicians’ work flow.

What of the programs other companies are developing in areas like medication management? “Clearly if there’s a tool that’s out there that works well, people should adapt it to their own situation,” Graf said. “What we are looking for are solutions to problems that have not been solved or solved well enough.”


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